Does G90.A require prior authorization?

No, G90.A does not require prior authorization (high confidence). Covered without prior authorization.

`G90.A`, Postural orthostatic tachycardia syndrome [POTS]

ICD-10-CM

No Prior Auth Required

Covered without prior authorization (high confidence)

For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Medical records maintained by the performing provider must clearly support medical necessity and include test reports and the interpreting provider's interpretation.
Supporting documentation should include relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures used to rule out more common causes of autonomic signs or symptoms.
For diagnostic tests report the test result if known; if results are not available, report the symptoms that prompted performance of the test.

Autonomic function testing is covered to confirm or exclude a specific autonomic nervous system disorder when medically necessary.
Repeat autonomic testing for patients with a diagnosed autonomic disorder is covered when there is a documented change in clinical status or a response to a therapeutic intervention.
No specific clinical indications are listed in this article; follow the Local Coverage Determination (LCD) L39400 for indications for magnesium testing or services.
VT: members with symptomatic sustained monomorphic VT when the tachycardia is drug-resistant or the member is drug-intolerant or does not desire long-term drug therapy
Cardiac catheter ablation procedures are medically necessary for atrial tachyarrhythmias in members who meet any of the following: resuscitated from sudden cardiac death due to atrial flutter or atrial fibrillation with a rapid ventricular response in the absence of an accessory pathway
Atrial tachyarrhythmias: members with a dual-chamber pacemaker and pacemaker-mediated tachycardia that cannot be treated effectively by drugs or by re-programming the pacemaker

A57024, Billing and Coding: Autonomic Function Testing

NGS-J6-L36236, Autonomic Function Testing

NGS-JK-L36236, Autonomic Function Testing

AETNA-CPB-0165, Cardiac Catheter Ablation

AETNA-CPB-0678, Gastric Pacing / Electrical Stimulation and Gastroesophageal Per Oral Endoscopic Myotomy

Ask Backwork about documentation requirements, denial risks, or coverage in your state.